Pricing Technologies Under Medicare: Methodological Options and Selection Criteria. A Background Paper.

摘要

The paper presents an overview of possible methodologies to price new medical technologies and reprice existing technologies covered under Medicare. The advantages and disadvantages of six alternative but not mutually exclusive alternatives are described. These methodologies include three centered on costs -- microcosting, statistical cost analysis and cost accounting -- and three methodologies -- competitive bidding, negotiation, and expert panels which attempt to incorporate value and other factors into the pricing decision in addition to costs. Criteria that could be used in selecting technologies for pricing using these methodologies are suggested. General criteria for technology selection include identifying technologies that show substantial price variability across providers or locales, changed production patterns or a significant increase in the number of providers. To assure high potential benefits in relation to the administrative costs of pricing or repricing technologies, additional useful criteria are to identify technologies which are high volume, high cost, have Medicare as the predominant payer, or other reasons to expect large cost savings. The researchers believe it would be possible to identify technologies with pricing problems relatively cheaply and easily and make repricing decisions on the basis of systematic reviews rather than on an ad hoc basis.